US5834470A - 6-(2-imidazolinylamino) quinoxaline compounds useful as α-2 adrenoreceptor agonists - Google Patents

6-(2-imidazolinylamino) quinoxaline compounds useful as α-2 adrenoreceptor agonists Download PDF

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US5834470A
US5834470A US08/911,570 US91157097A US5834470A US 5834470 A US5834470 A US 5834470A US 91157097 A US91157097 A US 91157097A US 5834470 A US5834470 A US 5834470A
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compounds
subject invention
subject
alkanyl
compound
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Peter Julian Maurer
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Procter and Gamble Co
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    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07DHETEROCYCLIC COMPOUNDS
    • C07D403/00Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00
    • C07D403/02Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings
    • C07D403/12Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings linked by a chain containing hetero atoms as chain links
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/12Antidiarrhoeals
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00Drugs for disorders of the respiratory system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00Drugs for disorders of the senses
    • A61P27/02Ophthalmic agents
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00Drugs for disorders of the senses
    • A61P27/02Ophthalmic agents
    • A61P27/06Antiglaucoma agents or miotics
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P27/00Drugs for disorders of the senses
    • A61P27/16Otologicals

Definitions

  • the subject invention relates to certain substituted 6-(2-imidazolinylamino)quinoxaline compounds.
  • the compounds have been found to be selective alpha-2 adrenoceptor agonists and are useful for treatment of one or more of respiratory disorders, particularly nasal congestion; ocular disorders, particularly glaucoma; and gastrointestinal disorders, particularly diarrhea.
  • COPD chronic obstructive pulmonary disease
  • the subject invention relates to methods of treating nasal congestion comprising administration, to a human or lower animal in need of such treatment of a safe and effective amount of a compound having the following structure: ##STR2## wherein: (a) R is unsubstituted C 1 -C 3 alkanyl or alkenyl; and
  • R' is selected from hydrogen; unsubstituted C 1 -C 3 alkanyl or alkenyl; unsubstituted C 1 -C 3 alkylthio or alkoxy; hydroxy; thiol; and halo.
  • the subject invention also relates to the use of such compounds for preventing or treating other respiratory, ocular and/or gastrointestinal disorders.
  • alkanyl means a saturated hydrocarbon substituent, straight or branched chain, unsubstituted or substituted.
  • alkenyl means a hydrocarbon substituent with one double bond, straight or branched chain, unsubstituted or substituted.
  • alkylthio means a substituent having the structure Q--S--, where Q is alkanyl or alkenyl.
  • alkoxy means a substituent having the structure Q--O--, where Q is alkanyl or alkenyl.
  • the subject invention involves compounds having the following structures: ##STR3##
  • R is unsubstituted alkanyl or alkenyl having from 1 to about 3 carbon atoms.
  • R is preferably alkanyl.
  • R is more preferably methyl or ethyl, most preferably methyl.
  • R' is selected from hydrogen; unsubstituted alkanyl or alkenyl having from 1 to about 3 carbon atoms; unsubstituted alkylthio or alkoxy having from 1 to about 3 carbon atoms; hydroxy; thiol; and halo.
  • R' is preferably hydrogen.
  • R' is also preferably alkanyl, more preferably methyl or ethyl, most preferably methyl.
  • R' which is alkylthio or alkoxy is preferably saturated, also preferably C 1 or C 2 , more preferably methylthio or methoxy.
  • R' which is halo is preferably chloro or bromo, more preferably chloro.
  • Preferred compounds of the subject invention are compounds having the following structure: ##STR4## where R and R' are as indicated in the following table:
  • the compounds of the subject invention are particularly useful for the treatment of nasal congestion associated with allergies, colds, and other nasal disorders with associated nasal congestion, as well as their sequelae (for example, sinusitis and otitis).
  • undesired side effects such as hypotension, drowsiness, hypertension, or insomnia can be avoided.
  • the subject compounds are believed to provide advantages in the treatment of nasal decongestion over related compounds through their ability to interact with alpha-2 adrenoceptors.
  • the subject compounds have been found to be alpha-2 adrenoceptor agonists which cause constriction of peripheral vascular beds in the turbinates.
  • the subject compounds have been found to have only weak alpha-1 agonist activity, and have little or no effect on the central nervous system.
  • the compounds of the subject invention are also useful for the treatment of ocular disorders associated with increased intraocular pressure, such as glaucoma.
  • the compounds are administered either perorally, or topically as drops, gels or creams directly to the surface of the mammalian eye.
  • the compounds of the subject invention are also useful for controlling gastrointestinal motility disorders, such as diarrhea, by antimotility and antisecretory actions on the gastrointestinal tract.
  • the pharmacological activity and selectivity of the subject compounds can be determined using published test procedures.
  • the alpha-2 selectivity of the compounds is determined by measuring receptor binding affinities and in vitro functional potencies in a variety of tissues known to possess alpha-2 and/or alpha-1 receptors. (See, e.g., The Alpha-2 Adreneraic Receptors, L. E. Limbird, ed., Humana Press, Clifton, N.J.)
  • the following in vivo assays are typically conducted in rodents or other species.
  • Central nervous system activity is determined by measuring locomotor activity as an index of sedation. (See, e.g., Spyraki, C. & H.
  • Antidiarrheal activity is determined by measuring the ability of the compounds to inhibit prostaglandin-induced diarrhea. (See, e.g., Thollander, M., P. Hellstrom & T. Svensson, "Suppression of Castor Oil-induced Diarrhea by Alpha-2 Adrenoceptor Agonists", Aliment. Pharmacol. Therap., Vol. 5 (1991), pp. 255-262).
  • Antiasthma activity is determined by measuring the effect of the compound on bronchoconstriction associated with pulmonary challenges such as inhaled antigens.
  • bronchoconstriction associated with pulmonary challenges such as inhaled antigens.
  • pulmonary challenges such as inhaled antigens.
  • Activity in cough is determined by measuring the number and latency of the cough response to respiratory challenges such as inhaled citric acid.
  • respiratory challenges such as inhaled citric acid.
  • the collected solid thiourea intermediate is dried on a vacuum line (16 h, 0.5 torr), suspended in bromobenzene (50 mL) and heated at reflux for six hours to effect conversion to the isothiocyanate intermediate which is not isolated.
  • the solution is cooled, then added dropwise to a solution of ethylene diamine (5.0 mL) in toluene (10 mL). The resulting mixture is stirred for 16 hours and filtered.
  • the solids are washed with toluene (20 mL) and dried under vacuum to yield 6-(N'-aminoethylthioureido)-5-methylquinoxaline.
  • compositions which comprise a safe and effective amount of a subject compound, or a pharmaceutically-acceptable salt thereof, and a pharmaceutically-acceptable carrier.
  • safe and effective amount means an amount of the subject compound sufficient to significantly induce a positive modification in the condition to be treated, but low enough to avoid serious side effects (at a reasonable benefit/risk ratio), within the scope of sound medical judgment.
  • a safe and effective amount of the subject compound will vary with the age and physical condition of the patient being treated, the severity of the condition, the duration of the treatment, the nature of concurrent therapy, the particular pharmaceutically-acceptable carrier utilized, and like factors within the knowledge and expertise of the attending physician.
  • compositions of the subject invention preferably comprise from about 0.0001% to about 99% by weight of the subject compound, more preferably from about 0.01% to about 90%; also preferably from about 10% to about 50%, also preferably from about 5% to about 10%, also preferably from about 1% to about 5%, and also preferably from about 0.1% to about 1%.
  • compositions of the subject invention contain a pharmaceutically-acceptable carrier.
  • pharmaceutically-acceptable carrier means one or more compatible solid or liquid filler diluents or encapsulating substances which are suitable for administration to a human or lower animal.
  • compatible means that the components of the composition are capable of being commingled with the subject compound, and with each other, in a manner such that there is no interaction which would substantially reduce the pharmaceutical efficacy of the composition under ordinary use situations.
  • Pharmaceutically-acceptable carriers must, of course, be of sufficiently high purity and sufficiently low toxicity to render them suitable for administration to the human or lower animal being treated.
  • substances which can serve as pharmaceutically-acceptable carriers or components thereof are sugars, such as lactose, glucose and sucrose; starches, such as corn starch and potato starch; cellulose and its derivatives, such as sodium carboxymethyl cellulose, ethyl cellulose, and methyl cellulose; powdered tragacanth; malt; gelatin; talc; solid lubricants, such as stearic acid and magnesium stearate; calcium sulfate; vegetable oils, such as peanut oil, cottonseed oil, sesame oil, olive oil, corn oil and oil of theobroma; polyols such as propylene glycol, glycerine, sorbitol, mannitol, and polyethylene glycol; alginic acid; emulsifiers, such as the Tweens®; wetting agents, such sodium lauryl sulfate; coloring agents; flavoring agents; tableting agents, stabilizers; antioxidants; preservatives; pyrogen-free
  • a pharmaceutically-acceptable carrier to be used in conjunction with the subject compound is basically determined by the way the compound is to be administered.
  • the preferred pharmaceutically-acceptable carrier is sterile, physiological saline, with blood-compatible suspending agent, the pH of which has been adjusted to about 7.4.
  • the preferred mode of administering the subject compounds is perorally.
  • the preferred unit dosage form is therefore tablets, capsules, lozenges, chewable tablets, and the like.
  • Such unit dosage forms comprise a safe and effective amount of the subject compound, which is preferably from about 0.01 mg to about 200 mg, more preferably from about 0.1 mg to about 50 mg, more preferably still from about 0.5 mg to about 25 mg, also preferably from about 1 mg to about 10 mg.
  • the pharmaceutically-acceptable carrier suitable for the preparation of unit dosage forms for peroral administration are well known in the art.
  • Tablets typically comprise conventional pharmaceutically-compatible adjuvants as inert diluents, such as calcium carbonate, sodium carbonate, mannitol, lactose and cellulose; binders such as starch, gelatin and sucrose; disintegrants such as starch, alginic acid and croscarmelose; lubricants such as magnesium stearate, stearic acid and talc. Glidants such as silicon dioxide can be used to improve flow characteristics of the powder mixture. Coloring agents, such as the FD&C dyes, can be added for appearance. Sweeteners and flavoring agents, such as aspartame, saccharin, menthol, peppermint, and fruit flavors, are useful adjuvants for chewable tablets.
  • inert diluents such as calcium carbonate, sodium carbonate, mannitol, lactose and cellulose
  • binders such as starch, gelatin and sucrose
  • disintegrants such as starch, alginic acid and croscar
  • Capsules typically comprise one or more solid diluents disclosed above.
  • the selection of carrier components depends on secondary considerations like taste, cost, and shelf stability, which are not critical for the purposes of the subject invention, and can be readily made by a person skilled in the art.
  • Peroral compositions also include liquid solutions, emulsions, suspensions, and the like.
  • the pharmaceutically-acceptable carriers suitable for preparation of such compositions are well known in the art.
  • Such liquid oral compositions preferably comprise from about 0.001% to about 5% of the subject compound, more preferably from about 0.01% to about 0.5%.
  • Typical components of carriers for syrups, elixirs, emulsions and suspensions include ethanol, glycerol, propylene glycol, polyethylene glycol, liquid sucrose, sorbitol and water.
  • typical suspending agents include methyl cellulose, sodium carboxymethyl cellulose, Avicel® RC-591, tragacanth and sodium alginate; typical wetting agents include lecithin and polysorbate 80; and typical preservatives include methyl paraben and sodium benzoate.
  • Peroral liquid compositions may also contain one or more components such as sweeteners, flavoring agents and colorants disclosed above.
  • compositions useful for attaining systemic delivery of the subject compounds include sublingual and buccal dosage forms.
  • Such compositions typically comprise one or more of soluble filler substances such as sucrose, sorbitol and mannitol; and binders such as acacia, microcrystalline cellulose, carboxymethyl cellulose and hydroxypropyl methyl cellulose. Glidants, lubricants, sweeteners, colorants, antioxidants and flavoring agents disclosed above may also be included.
  • a preferred mode of administering the subject compounds is topically to the site where activity is desired: intranasal doses for nasal decongestion, inhalants for asthma, eye drops, gels and creams for ocular disorders, and peroral doses for gastrointestinal disorders.
  • compositions of the subject invention include aqueous solutions comprising a safe and effective amount of a subject compound intended for topical intranasal administration.
  • Such compositions preferably comprise from about 0.001% to about 5% of a subject compound, more preferably from about 0.01% to about 0.5%.
  • Such compositions also typically include safe and effective amounts of preservatives, such as benzalkonium chloride and thimerosal; buffers such as phosphate and acetate; tonicity agents such as sodium chloride; antioxidants such as ascorbic acid; aromatic agents; and acids and bases to adjust the pH of these aqueous compositions as needed.
  • compositions of the subject invention include aqueous solutions, suspensions, and dry powders comprising a safe and effective amount of a subject compound intended for atomization and topical inhalation administration.
  • Such compositions preferably comprise from about 0. 1% to about 50% of a subject compound, more preferably from about 1% to about 20%.
  • Such compositions are typically contained in a container with attached atomizing means.
  • compositions also typically include propellants such as chlorofluorocarbons 12/11 and 12/114; solvents such as water, glycerol and ethanol; stabilizers such as ascorbic acid, sodium metabisulfite; preservatives such as cetylpyridinium chloride and benzalkonium chloride; tonicity adjustors such as sodium chloride; and flavoring agents such as sodium saccharin.
  • propellants such as chlorofluorocarbons 12/11 and 12/114
  • solvents such as water, glycerol and ethanol
  • stabilizers such as ascorbic acid, sodium metabisulfite
  • preservatives such as cetylpyridinium chloride and benzalkonium chloride
  • tonicity adjustors such as sodium chloride
  • flavoring agents such as sodium saccharin.
  • compositions of the subject invention include aqueous solutions comprising a safe and effective amount of a subject compound intended for topical intraocular administration.
  • Such compositions preferably comprise from about 0.0001% to about 5% of a subject compound, more preferably from about 0.01% to about 0.5%.
  • compositions also typically include one or more of preservatives, such as benzalkonium chloride, thimerosal, phenylmercuric acetate; vehicles, such as poloxamers, modified celluloses, povidone and purified water; tonicity adjustors, such as sodium chloride, mannitol and glycerin; buffers such as acetate, citrate, phosphate and borate; antioxidants such as sodium metabisulfite, butylated hydroxy toluene and acetyl cysteine; acids and bases may be used to adjust the pH of these formulations as needed.
  • preservatives such as benzalkonium chloride, thimerosal, phenylmercuric acetate
  • vehicles such as poloxamers, modified celluloses, povidone and purified water
  • tonicity adjustors such as sodium chloride, mannitol and glycerin
  • buffers such as acetate, citrate, phosphate and borate
  • compositions of the subject invention include solids, such as tablets and capsules, and liquids, such as solutions, suspensions and emulsions (preferably in soft gelatin capsules), comprising a safe and effective amount of a subject compound intended for topical administration to the gastrointestinal tract by peroral administration.
  • Such compositions preferably comprise from about 0.01 mg to about 100 mg per dose, more preferably from about 0.1 mg to about 5 mg per dose.
  • Such compositions can be coated by conventional methods, typically with pH or time-dependent coatings, such that the subject compound is released in the gastrointestinal tract in the vicinity of the desired topical application, or at various times to extend the desired action.
  • Such dosage forms typically include, but are not limited to, one or more of cellulose acetate phthalate, polyvinylacetate phthalate, hydroxypropyl methyl cellulose phthalate, ethyl cellulose, Eudragit® coatings, waxes and shellac.
  • compositions of the subject invention may optionally include other drug actives.
  • drug actives which may be incorporated in the subject compositions, and typical dosage amounts of them, include: respiratory drug actives: classical antihistamines, e.g., chlorpheniramine from about 1 mg to about 4 mg per dose, and diphenhydramine from about 10 mg to about 50 mg per dose; nonsedating antihistamines, e.g., terfenadine from about 30 mg to about 60 mg per dose, loratadine from about 5 mg per dose to about 10 mg per dose, and cetirizine from about 5 mg per dose to about 10 mg per dose; expectorants, e.g., guaifenesin from about 100 mg to about 200 mg per dose; antitussives, e.g., dextromethorphan from about 5 mg to about 30 mg per dose; and analgesics, e.g., ibuprofen from about 100 mg to about 800 mg per dose, and
  • the subject invention involves methods for preventing or treating nasal congestion by administering a safe and effective amount of a subject compound to a human or lower animal experiencing or at risk of experiencing nasal congestion.
  • Such nasal congestion may be associated with human diseases or disorders which include, but are not limited to, seasonal allergic rhinitis, acute upper respiratory viral infections, sinusitis, perennial rhinitis, and vasomotor rhinitis.
  • Each administration of a dose of the subject compound preferably administers a dose within the range of from about 0.001 mg/kg to about 10 mg/kg of a compound, more preferably from about 0.01 mg/kg to about 5 mg/kg, more preferably still from about 0.1 mg/kg to about 1 mg/kg. Peroral administration of such doses is preferred.
  • the frequency of administration of a subject compound according to the subject invention is preferably from about once to about six times daily, more preferably from about 2 times to about 4 times daily. Such doses and frequencies are also preferred for treating other respiratory conditions, such as otitis media, cough, COPD and asthma.
  • Another aspect of the subject invention involves methods for preventing or treating glaucoma by administering a safe and effective amount of a subject compound to a human or lower animal experiencing or at risk of experiencing glaucoma.
  • Each administration of a dose of the subject compound preferably administers a dose within the range of from about 0.01 ⁇ g/kg to about 10 mg/kg of a compound, more preferably from about 0.001 mg/kg to about 1 mg/kg, more preferably still from about 0.01 mg/kg to about 0.1 mg/kg. Intraocular administration of such doses is preferred.
  • the frequency of administration of a subject compound according to the subject invention is preferably from about once to about six times daily, more preferably from about 2 times to about 4 times daily.
  • Another aspect of the subject invention involves methods for preventing or treating functional bowel disorders, such as diarrhea, by administering a safe and effective amount of a subject compound to a human or lower animal experiencing or at risk of experiencing diarrhea.
  • Each administration of a dose of the subject compound preferably administers a dose within the range of from about 0.001 mg/kg to about 10 mg/kg of a compound, more preferably from about 0.01 mg/kg to about 5 mg/kg, more preferably still from about 0.1 mg/kg to about 1 mg/kg. Peroral administration of such doses is preferred.
  • the frequency of administration of a subject compound according to the subject invention is preferably from about once to about six times daily, more preferably from about 2 times to about 4 times daily.

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US08/911,570 1993-12-17 1997-08-14 6-(2-imidazolinylamino) quinoxaline compounds useful as α-2 adrenoreceptor agonists Expired - Fee Related US5834470A (en)

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CN (1) CN1137755A (de)
AT (1) ATE194771T1 (de)
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US20050026924A1 (en) * 2000-07-14 2005-02-03 Allergan, Inc. Compositions containing alpha-2-adrenergic agonist components
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US20080241290A1 (en) * 2007-03-30 2008-10-02 Wayne Jeffrey Perry Sinus relief composition and method of producing the same
US20080242741A1 (en) * 2007-03-30 2008-10-02 Wayne Jeffrey Perry Intranasal drug delivery system
US20090069433A1 (en) * 2007-09-10 2009-03-12 Wayne Jeffrey Perry Nasal rinse additive
US20090069446A1 (en) * 2007-09-06 2009-03-12 Wayne Jeffrey Perry Dendritic salt therapeutic agent delivery system
EP2218442A1 (de) 2005-11-09 2010-08-18 CombinatoRx, Inc. Verfahren, Zusammensetzungen und Kits zur Behandlung von ophthalmologischen Erkrankungen
WO2013016178A1 (en) * 2011-07-25 2013-01-31 Allergan, Inc. N-(imidazolidin-2-ylidene)quinoline derivatives as modulators of alpha 2 adrenergic receptors
US8858961B2 (en) 2000-07-14 2014-10-14 Allergan, Inc. Compositions containing alpha-2-adrenergic agonist components
US9301988B2 (en) 2007-03-30 2016-04-05 Hi-Tech Pharmacal Co., Inc. Method of treatment using a therapeutic agent for intranasal administration

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US6194415B1 (en) 1995-06-28 2001-02-27 Allergan Sales, Inc. Method of using (2-imidazolin-2-ylamino) quinoxoalines in treating neural injury
US5856329A (en) 1995-06-28 1999-01-05 Allergan Method of using (2-imidazolin-2-ylamino) quinoxalines in treating ocular neural injury
BR9713536A (pt) 1996-11-25 2000-11-07 Procter & Gamble Compostos heterocìclicos de guanidinila úteis como agonistas de adrenoceptores alfa-2
CN1244864A (zh) * 1996-11-25 2000-02-16 普罗克特和甘保尔公司 用作α-2肾上腺素能受体兴奋剂的2-咪唑啉基氨基吲唑化合物
US6841684B2 (en) 1997-12-04 2005-01-11 Allergan, Inc. Imidiazoles having reduced side effects
US6329369B1 (en) 1997-12-04 2001-12-11 Allergan Sales, Inc. Methods of treating pain and other conditions
US20030087962A1 (en) 1998-10-20 2003-05-08 Omeros Corporation Arthroscopic irrigation solution and method for peripheral vasoconstriction and inhibition of pain and inflammation
US7973068B2 (en) 1998-10-20 2011-07-05 Omeros Corporation Arthroscopic irrigation solution and method for peripheral vasoconstriction and inhibition of pain and inflammation
DE69924536T2 (de) * 1998-10-20 2006-02-16 Omeros Corp., Seattle Spülende lösung und methoden zur hemmung von schmerzen und entzündungen
US7030149B2 (en) 2002-04-19 2006-04-18 Allergan, Inc. Combination of brimonidine timolol for topical ophthalmic use
US9522153B2 (en) 2009-12-22 2016-12-20 Allergan, Inc. Compositions and methods for lowering intraocular pressure

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